In the case of thrombosed external hemorrhoids, if the thrombosis is very large and painful, excising the clot may be necessary and can be performed in the office. Mild symptomatic internal hemorrhoids can resolve with dietary and lifestyle changes. If constipation is the primary cause then a high-fiber diet and more fluids can help. If diarrhea is the culprit, it is important to find the cause of the diarrhea and treat accordingly. Eliminating straining and sitting on the toilet for long periods of time often helps to prevent symptoms. Topical creams and ointments such as hydrocortisone may help alleviate symptoms. If these conservative interventions fail to improve symptoms, a formal evaluation and treatment of hemorrhoids by a colon and rectal surgeon either in the office or the operating room may be warranted.